Ask Questions Before Taking Antibiotics

Antibiotic resistance questions and answers

/ Author:  / Reviewed by: Joseph V. Madia, MD

You've probably heard of “superbugs,” the name for infections that have built up a dangerous resistance to antibiotics. Could you or your doctor be contributing to their rise?

Antibiotics, or antimicrobial drugs, have saved many lives from bacterial infections. But the bad bugs are catching on, and morphing into illnesses that are much tougher to fight.

Public health experts blame overprescription and unnecessary use for the rise of antibiotic resistance. Dr. Lauri Hicks, Medical Director of the Center for Disease Control and Prevention's Get Smart: Know When Antibiotics Work program, says the responsibility lies with both doctors and patients.

Antibiotics are often prescribed for non-bacterial infections, like coughs and colds or viral infections, Dr. Hicks said. In fact, antibiotics are unnecessary 50 percent of the time that they are prescribed.

Patients have become accustomed to getting antibiotics when they go into their doctor's office, and ask doctors specifically for a prescription. Sometimes doctors may give patients a prescription if they're not clear on the diagnosis.

Dr. Hicks encourages patients to talk to their doctors about what the best treatment is for their sickness, without putting pressure on them to prescribe antibiotics. But if you are taking an antibiotic, use it properly – finish the entire prescription, even if you're feeling better.

Want to know more about how antibiotic resistance impacts medical treatment, and how you should approach antibiotics as a patient? Read on to learn Dr. Hicks' answers to common questions.

DailyRx: Can you give me a brief history of antibiotic resistance and what it means?
Dr. Hicks: Antibiotics, also known as antimicrobial drugs, are drugs that fight infections caused by bacteria.

Alexander Fleming discovered the first antibiotic, penicillin, in 1928. After the first use of antibiotics in the 1940s, they transformed medical care and dramatically reduced illness and death from infectious diseases.

Shortly after the first use of antibiotics, there was evidence of resistance.
Antibiotic resistance occurs when bacteria change in a way that reduces or eliminates the effectiveness of antibiotics.  Infections with resistant bacteria have become more common in healthcare and community settings, and many bacteria have become resistant to more than one type or class of antibiotic. 

How does antibiotic resistance develop?

Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm.

Bacteria can do this through several mechanisms. Some bacteria develop the ability to neutralize the antibiotic before it can do harm, others can rapidly pump the antibiotic out, and still others can change the antibiotic attack site so it cannot affect the function of the bacteria.

Antibiotics kill or inhibit the growth of susceptible bacteria. Sometimes, one of the bacteria survives because it has the ability to neutralize or escape the effect of the antibiotic; that one bacterium can then multiply and replace all the bacteria that were killed off.

Exposure to antibiotics therefore provides selective pressure, which makes the surviving bacteria more likely to be resistant. In addition, bacteria that were at one time susceptible to an antibiotic can obtain resistance through mutation of their genetic material or by acquiring pieces of DNA that code for the resistance properties from other bacteria.

The DNA that codes for resistance can be grouped in a single easily transferable package. This means that bacteria can become resistant to many antimicrobial agents because of the transfer of one piece of DNA.

Doctors are being blamed for prescribing too many antibiotics. Would you say that's true, and how does over-prescription impact patients? Are some doctors more likely than others to over-prescribe antibiotics?

Both providers and patients contribute to the prescribing of unnecessary antibiotics.

Patients often put pressure on their doctors to prescribe antibiotics, thinking they will help them get back to work faster or get rid of symptoms. Providers may succumb to that pressure to keep their patients satisfied or may prescribe an unnecessary antibiotic due to diagnostic uncertainty.
Parent pressure makes a difference. For pediatric care, a study showed that doctors prescribe antibiotics 62 percent of the time if they perceive parents expect them and 7 percent of the time if they feel parents do not expect them.
Antibiotic use promotes development of antibiotic-resistant bacteria. Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply.

Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria. Smart use of antibiotics is the key to controlling the spread of resistance.
Unnecessary antibiotic use may also lead to adverse drug events, like serious allergic reactions or a C. difficile infection. In children, reactions to antibiotics are the most common cause of emergency department visits for adverse drug events. 

Primary care physicians, the doctors who frequently treat upper respiratory tract infections, like colds and flu, prescribe the most courses of antibiotics.
What should patients know about antibiotics?

Patients should know that antibiotics are our best tool to treat bacterial infections, but they should only be used when necessary. Using antibiotics when you don’t need them may do more harm than good.

It is estimated that more than 50% of antibiotics are unnecessarily prescribed in offices and hospitals.

When should patients take antibiotics, and when should they not?

Antibiotics should only be prescribed for bacterial infections, like strep throat. Patients should only take antibiotics when their provider says they are necessary to treat the infection.

Patients shouldn’t demand antibiotics, but should ask their doctor what the best treatment is for their illness…it may be symptomatic relief. Antibiotics can treat strep throat and some ear infections.

What is the next course of treatment if a patient has an antibiotic-resistant strain of illness?

Antibiotic resistance can cause significant danger and suffering for people who have common infections that once were easily treatable with antibiotics.

When antibiotics fail to work, the consequences are longer-lasting illnesses, more doctor visits or extended hospital stays, and the need for more expensive and toxic medications.

Some resistant infections can even cause death.

What types of illnesses should patients be wary of being over-prescribed antibiotics for? (In other words, what's a situation where a doctor might prescribe an antibiotic and patients should think twice before accepting this advice?)

It is estimated that more than 50 percent of antibiotics are unnecessarily prescribed in office settings for upper respiratory infections (URIs) like cough and cold illness, sinusitis and bronchitis, most of which are caused by viruses.

For example, children may have up to nine colds each year. Three out of 10 children who visit an outpatient provider with the common cold receive an antibiotic. This is an improvement from previous years, but antibiotics are never indicated for a common cold.

We encourage patients to talk with their doctor about what the best treatment would be for their illness without putting pressure on their doctor to prescribe antibiotics. It’s also important to use antibiotics appropriately when they are prescribed.

This means finishing the entire prescription even if feeling better, and not saving or sharing antibiotics.

How does over-prescribing impact public health in general?

The way we use antibiotics today or in one patient directly impacts how effective they will be tomorrow or in another patient; they are a shared resource. Antibiotic resistance is not just a problem for the person with the infection.

Some resistant bacteria have the potential to spread to others – promoting antibiotic‐resistant infections.  Since it will be many years before new antibiotics are available to treat some resistant infections, we need to improve the use of antibiotics that are currently available.

Review Date: 
May 25, 2012